Injections and meth use

[oneforfighting]

Have a patient who came in for MBBs but was noted to be tachycardic and hypoxic requiring 2L NC. Not normally on O2. States that meth was used night before and that they use every 2 weeks. Already in therapy, PCP aware. Not sure if they've seen addiction med but access would be difficult where I am at anyway. In this case, I instructed pt to go to ED but they refused.
I told them that I would be okay trying injections again in future if vitals stable but I wanted to see what others do in similar situation. Probably allow for one more attempt and that's it. Also, would you have patient see PCP/cards to clear them for injection? Thanks all in advance.

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[RoloTomassi]

Meth causes hypoxia? Regardless just say no. They have more pressing issues than chronic axial LBP

 

[cowboydoc]

PT, maybe an OTC LSO. No meds, no sharp objects.

 

[Ducttape]

if they are using meth, there are much greater issues than a median branch block, and the risks of complications from meth use being attributed to your injection are too high.

 

[Laryngospasm]

They will blame you for every issue they have.. and tell everyone they know how they are worse because of you.. don’t touch with ten foot pole.

 

[oreosandsake]

Injections didn’t work
Gimme them Oxys!

 

[oneforfighting]

Thanks all. Will hold off on injections.

Sorry for the late response, I never received notifications from SDN that anyone replied to this thread. Guess I have to check these manually from now on.

 

[oneforfighting]

Meth causes hypoxia? Regardless just say no. They have more pressing issues than chronic axial LBP

Pulmonary HTN I guess.
This is what I found:

Methamphetamine induced transient dynamic pulmonary artery hypertension | American Journal of Respiratory and Critical Care Medicine; 203(9), 2021. | EMBASE

pesquisa.bvsalud.org

 

[oneforfighting]

So this patient is returning to clinic Monday but I am stuck on how to tell him that I will no longer inject him. Partly because I would essentially be telling him I have nothing else to offer since PT has already been ordered and I wouldn't offer meds.

Something along the lines of, "Injection may make your pain worse while you are on meth"? "It may worsen your hypoxia"? I just don't want to throw something out there that I don't have literature to support especially since he's had an RFA at same level in past with good results. How would you guys word it?

And what if he asks "when would I be able to do injections again?"
Once he's sober for 6 months to 1 year with letter from MH specialist?

My other thought is to give him one more chance after he's medically cleared by his PCP. If he has anymore tachycardic/hypoxic episodes, then he's done. I don't use sedation.

 

[Agast]

Tell the patient that there is no way of knowing what goes into street drugs and what’s going to really be in his system when he takes it. And you would not want to make a bad situation worse by doing a procedure during that time. We make people stop certain drugs before they have procedures because of *known* risks and here you are dealing with *unknown* risks. And if he really wants to help his back pain he would sober up and help his internal organs. Give him some information for how to get help. AA, detox, something. And tell him you absolutely 100% care about him but he needs to care about himself, too.

 

[oneforfighting]

Tell the patient that there is no way of knowing what goes into street drugs and what’s going to really be in his system when he takes it. And you would not want to make a bad situation worse by doing a procedure during that time. We make people stop certain drugs before they have procedures because of *known* risks and here you are dealing with *unknown* risks. And if he really wants to help his back pain he would sober up and help his internal organs. Give him some information for how to get help. AA, detox, something. And tell him you absolutely 100% care about him but he needs to care about himself, too.

Thank you. This is really good. Would you ever consider doing injections on him again/what if he asks when could he get injections in future?

 

[Agast]

There’s a good chance he doesn’t come back. Addicts usually aren’t receptive to the idea of getting clean unless there’s a lot at stake and someone to make them follow through.

If he actually does though, I would do the procedures for him.

 

[MitchLevi]

Can't you just say you've got a zero tolerance approach?

I would just tell the pt his lifestyle and my practice don't jive, give him numbers to an addiction clinic and wish him good luck.

Despite what many of us think about ourselves, none of us are special and there are tons of us out there in the world treating pain, doing shots, Rx'ing...

Let this guy be someone else's problem...I would.

 

[oneforfighting]

There’s a good chance he doesn’t come back. Addicts usually aren’t receptive to the idea of getting clean unless there’s a lot at stake and someone to make them follow through.

If he actually does though, I would do the procedures for him.

Thanks. I appreciate all the suggestions. Maybe it should be, but this just isn’t as clear cut to me as the previous commenters made it seem. This doesn’t strike me as the type of guy who is looking for secondary gain but rather someone going through a tough time.

 

[oneforfighting]

Can't you just say you've got a zero tolerance approach?

I would just tell the pt his lifestyle and my practice don't jive, give him numbers to an addiction clinic and wish him good luck.

Despite what many of us think about ourselves, none of us are special and there are tons of us out there in the world treating pain, doing shots, Rx'ing...

Let this guy be someone else's problem...I would.

Definitely a good suggestion and another approach to consider. I guess I haven’t given this much thought until now so my policies aren’t fleshed out.

 

[Tboned]

Have a patient who came in for MBBs but was noted to be tachycardic and hypoxic requiring 2L NC. Not normally on O2. States that meth was used night before and that they use every 2 weeks. Already in therapy, PCP aware. Not sure if they've seen addiction med but access would be difficult where I am at anyway. In this case, I instructed pt to go to ED but they refused.
I told them that I would be okay trying injections again in future if vitals stable but I wanted to see what others do in similar situation. Probably allow for one more attempt and that's it. Also, would you have patient see PCP/cards to clear them for injection? Thanks all in advance.

Ok to try injections again if vitals stable? That’s you’re criteria? More like ok to do injections only if verifiably clean at absolute minimum. Don’t be so naive and don’t get involved with that crap. It’s not worth it. Agree with others in that this patient has bigger problems than your ESI or MBB